Monday, November 12, 2012

It's been about five months since I've written... I'm a bit of a blogging failure this year. But I've had this one in the works for a long time now, so I thought I'd finish it off and get it out there.

One of the best things about being a graduate of Regent College is getting to go back and audit classes at half the price. Last May I audited a class called "Darkness is my Only Companion," with a rather bleak title taken from Psalm 88. The class was about mental illness and pastoral care, which definitely falls into the "need-to-know" category for me in my work! In fact, during the two weeks of the class, I had two friends hospitalized for suicidal tendencies brought on by bipolar disorder and depression.

The class was taught by Kathryn Greene-McCreight, an Episcopal priest from New Hampshire who has bipolar disorder. Her life experience was such a rich source of learning, as were the in-class discussions with my classmates, who included people living with mental illness, people who grew up with a mentally ill parent, people who had children or siblings or friends with mental illnesses, chaplains, prison workers, pastors, and medical professionals.

I'd like to write two posts about things I learned or was reminded of during the class. Next week, I'll write a post for those seeking to be good pastors and friends of people with mental illnesses. But first, in this post, I'll go over some the top 5 general facts about mental illness that struck me or surprised me. (I'm swallowing my pride and revealing my general ignorance!)

1. Many mental illnesses run in families.

Before the class, I had no idea that there was any genetic aspect to mental illness. My prof talked about studies that have been done on people with the three major illnesses (depression, bipolar disorder, and schizophrenia). Children who have one parent with a mood disorder (depression or bipolar) have a 15-30% chance of developing a mood disorder, and if both parents have a mood disorder, the child's risk factor jumps to 50-75%. Children with a schizophrenic parent have 5-15% chance of developing schizophrenia, and that risk also jumps to 75% if both parents are schizophrenic.

Having said that, mental illness is by no means strictly a genetic phenomenon. A study of identical twins showed that if one twin was schizophrenic, the other twin only had a 50% chance of also being schizophrenic. Even though they had the same DNA, in half of the cases, the genes for schizophrenia were only triggered in one twin. It seems that the presence of inner stressors (e.g. physical trauma and illness) and exterior stressors (e.g. poverty, isolation, abuse, drug use) are very crucial factors in determining whether someone's genetic potential for mental illness will actually reveal itself in the person's life.

2. The major mental illnesses have no cure.

For
whatever reason, this
fact struck me like none other in the class. I think I'd
always thought that mental illnesses could go away eventually, or at
least go into remission, allowing the sufferer to live a relatively
normal life. In fact, major mental illnesses require lifelong
management and care, like diabetes. They can be managed, but they will not go away. This is one of the
overwhelming and sobering aspects of being diagnosed.

The
search for a cure continues, but mental illnesses are among the most
complex of all diseases, with a variety of environmental and genetic
factors, and the research isn't as well funded as other less-stigmatized
diseases.

3. While the major mental illnesses are incurable, medication and therapy do help, especially in combination.

My professor was especially good at talking about this, since she's tried just about everything to manage her bipolar. Through literally years of trial and error, she and her doctor have found a mixture of medications that work for her. However, as she puts it, bipolar medication "tends to create a ceiling but not a floor." That is, it helps contain the high (manic) episodes, but the low (depressive) periods are less responsive to medication, and she often has to ride them out.

The side effects of medication are also a constant challenge for people with mental illness, especially when these medications are taken constantly over a lifetime: changes in weight, nausea, headaches, drowsiness, restlessness, confusion, seizures, heart problems... My prof had a stroke recently, and her doctors believe it was her bipolar medication that made her prone to strokes at such a young age. Medication is a life-saver for many sufferers, but it is a long road to finding the right mix, and the side effects and health risks remain.

Humans are not only chemical creatures, but also relational creatures, which is why my professor recommended regular therapy alongside medication. Therapists listen and help talk through strategies for living with and managing the effects of the illness.

4. Electroconvulsive therapy (ECT) is used effectively today, and is much different than what we see in the movies.

This really surprised me. I'd assumed ECT (aka "shock therapy") was an inhumane and now-banned quasi-torture performed by doctors who were a bit sadistic and didn't have a good grasp of mental illness. (I watch too many movies.)

Nope. Turns out those doctors actually had a pretty good grasp of mental illness, and they've refined the procedure to make it less... torturous. These days, patients are put to sleep before the procedure, and the electricity is targeted directly to the brain, so there are no bodily convulsions beyond a slight toe wiggle or eyelash flutter. The shock to the brain acts like a "reset" switch, and can be more effective than medication. For people suffering with depression, antidepressants are effective about 50% of the time, but ECT is effective 75-90% of the time. It can, however, have side effects, like memory loss and confusion. There's a great TED talk about ECT here.

5. Most people who attempt or commit suicide do not actually want to die, they just want their pain to end.

Pretty self-explanatory, but it was a good reminder for me. Other suicide-related facts that surprised me:
- Males are four times more likely to commit suicide than females, but suicide attempt rates are 3-6 times higher for females than for males.
- In the USA (and probably in Canada too), a person is about 50% more likely to kill themselves than to be killed by someone else.
- More than 90% of people who commit suicide have a diagnosable mental illness.
- Talking about suicide with someone who is suicidal actually decreases their risk of completing suicide, so long as it is not discussed in a joking or glorifying way.

Those were my Top 5 general-knowledge-type lessons from the class. Stay tuned for ideas about how pastors and friends can helpfully interact with people who struggle with mental illness.